With salaries on par with those of secretaries, Czech MDs prepare for strike
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* Anita Elash

Early this spring, Czech doctors voted to do what would have been unthinkable - and impossible - just a decade ago under the communist regime: to go on strike.

Their demands are simple - they want their salaries increased by two-thirds. If the law that regulates their compensation is not changed by this autumn, they say, they will first make life miserable for health administrators, and then they will withdraw all but emergency services.

They have already started their campaign with a poster that tells hospital patients their physicians are earning roughly Cdn$3.50 an hour. "Doesn't this worry you?" it asks.

Dr. Milan Kubek, the internist who leads the physician trade union (LOK) and is organizing the strike, admits that physicians have been reluctant to join the union and are reticent about striking. After decades of enforced membership in the communist-controlled Revolutionary Trade Union, most Czechs are repulsed by the idea of organized labour. But he says LOK's 2500 members have become so disillusioned by their meagre earnings they are willing to set aside their old fears.

"We were told the government would bring the economy to a normal Western model and that once the country becomes richer, we, the intelligentsia, will profit," he says. "It is 10 years after the revolution and that hasn't happened. Doctors must realize they have been deceived."

Medical life here has improved enormously since the East Bloc began to crumble in 1989. Since the "velvet revolution," physicians have won the right to belong to democratic organizations such as LOK and to the Czech Medical Association, to set up their own private practices, to travel to medical conferences outside the country and to learn about and provide the latest treatments.

Health care spending now stands at 7% of the gross national product, up from 5.4% in 1990, and much of the additional money is being spent on new equipment. The country now has more than 60 computed tomography scanners, compared with a half dozen 10 years ago. Organ transplants are being performed at roughly the same rate as in Western Europe, and hemodialysis, which the communist regime restricted to people under age 60, is available to anyone who needs it.

But even if doctors practise Western-style medicine, they do not earn Western-style salaries. Although their incomes have improved dramatically over the last decade, physicians argue that their position in society has changed little since the communist era, when the work of the intelligentsia was considered less valuable than that of common labourers. According to the medical licencing body, the Czech Medical Chamber (CLK), physicians today earn an average of $950 a month, providing they work 80 hours of overtime. The average Czech industrial salary is $530; doctors' earnings are roughly equal to those of secretaries and sales assistants.

CLK president Dr. David Rath says the problem is especially acute among young doctors. A newly graduated general practitioner can expect to start a hospital practice earning a base salary of $275. But even older doctors often don't earn as much as neighbours who are managing shops or dispensing bank loans. To boost their incomes, Rath says up to 20% of physicians moonlight in unrelated fields, such as driving taxis and selling cars.

The humiliation of selling cars to make ends meet is bad enough, but Rath says patients also suffer because many doctors are too tired, unhappy or distracted to take the time to talk to them. People with routine complaints can usually expect to spend just a few minutes with their doctor and to leave with a prescription but without an explanation of what is wrong. "We have CAT scanners but we do not have good communication with patients," he says. "[And doctors] have problems with their family because they don't have the money to live a good life . . . . If you have economic problems you aren't that interested in medicine."

The left-leaning Czech government has so far dismissed doctors' demands for a minimum wage of Cdn$1590 a month as "unrealistic." But negotiations are continuing, and health officials say they agree, at least in principle, that doctors, along with all other Czechs, deserve to earn more money.

"Everyone agrees that everyone deserves a pay raise, but it's impossible to do it now," says health ministry spokesman David Vlk. A pay raise for doctors would mean increasing health insurance fees. LOK and the CLK have also proposed that, for the first time in more than 50 years, patients pay for health services. But the economy is deep in recession and unemployment is expected to rise to nearly 11% this year. Vlk says the government is not inclined to risk its neck by asking voters for more money, even if the request would bring the Czech Republic one step closer to implementing the modern system it covets.

Anita Elash is a Canadian journalist based in Prague.